LAPP Australia Pty Ltd
                                                                                                 lappaustralia.com.au
                   Account Application Form
                   To apply for a credit account, please complete the following forms and return them back to us.
                   Company Name                         ………………………………………………….…………….…………….
                   Trading Name                         ……………………………………………………………………………..
                   Delivery Address                     Street ………………………………………………………………….
                                                        Suburb …………………………………………………………………
                                                        State   …………………………………………………………………
                                                        Zip Code………………………………………………………………
                   Invoice Address                      PO Box………………………………………………….
                                                        Suburb………………………………………………….
                                                        State   ………………………………………………..
                                                        Zip Code………………………………………………
                   ABN                                          ………………………………………………….
                   Phone Number                                 ………………………………………………….
                   Fax Number                                   ………………………………………………….
                   Accounts Email Address                       ………………………………………………….
                   Type of Business                             ………………………………………………….
                   Name of Managing Director                    ………………………………………………….
                              Lapp Australia Pty Ltd A.B.N. 93 622 276 699 12 Grevillea Street, Eastern Creek, 2766 NSW
                    AUSTRALIA
                                                                                              LAPP Australia Pty Ltd
                                                                                                   lappaustralia.com.au
                    Trade References
                    For trade references, please do not include utilities (ie Power and Phone services).
                                                    1) ………………………………………………….
                                                    Phone……………………………………………
                                                    FAX……………………………………………….
                                                    2)  ………………………………………………….
                                                    Phone……………………………………………
                                                    FAX……………………………………………….
                                                    3)  ………………………………………………….
                                                    Phone……………………………………………
                                                    FAX……………………………………………….
                    I (we) understand that the Terms and Conditions for a Credit Account which are included in the
                    bottom of this document. I (we) declare we are authorised to create a Credit Account on behalf of
                    our company.
                    Signature      ………………………………………………….
                    Name           ………………………………………………….
                    Position       ………………………………………………….
                    Date           ………………………………………………….
                               Lapp Australia Pty Ltd A.B.N. 93 622 276 699 12 Grevillea Street, Eastern Creek, 2766 NSW
                     AUSTRALIA
                                                                                           LAPP Australia Pty Ltd
                                                                                                lappaustralia.com.au
                   When completed please return this form to our accounts team via the contact details listed on 
                   this document.
                   Once we have approved your account, how should we get back in touch with you?
                   Email                 ………………………………………………….
                                  or
                   Phone                 ………………………………………………….
                   Once completed, please send this form to ‘sales@lappaustralia.com.au’ for processing.
             Your Key Contacts
             To help us contact the right people in your company, you might want to list some of the key contacts
             at your company. These could include engineers, purchasing people, accounts people etc. Then
             when we are contacting you, we know the right people to get in touch with.
             Name         ………………………………………………….                 Name           ………………………………………………….
             Role         ………………………………………………….                 Role           ………………………………………………….
             Phone        ………………………………………………….                 Phone          ………………………………………………….
             Mobile       ………………………………………………….                 Mobile         ………………………………………………….
             Email        ………………………………………………….                 Email          ………………………………………………….
                   *Feel free to add more contacts to this form, depending on your company structure
                              Lapp Australia Pty Ltd A.B.N. 93 622 276 699 12 Grevillea Street, Eastern Creek, 2766 NSW
                    AUSTRALIA
                                                                                                    LAPP Australia Pty Ltd
                                                                                                         lappaustralia.com.au
                     Our Contact Details
                            General Enquiries       Free Phone                    1800 931 559
                                                    Email                 sales@lappaustralia.com.au
                            Account Enquires        Email              accounts@lappaustralia.com.au 
                     Our Bank Account Details
                     We email all invoices to your account’s email address on a daily basis, and monthly we
                     will email you with a complete statement with all your open invoices.
                     For payments from Australian bank accounts in $AUD
                     Payment to:     Lapp Australia Pty Ltd
                                     ANZ Banking Group (Australia)
                                     BSB:    013408
                                     Account Number:  3068-66341
                                 Lapp Australia Pty Ltd A.B.N. 93 622 276 699 12 Grevillea Street, Eastern Creek, 2766 NSW
                      AUSTRALIA